Pediatric Intestinal Biopsy
Pediatric Intestinal Biopsy
Overview
Intestinal biopsy in pediatric patients is a crucial diagnostic procedure for evaluating various gastrointestinal disorders. It involves obtaining tissue samples from different parts of the intestinal tract for histological, immunological, and molecular analysis.
Key Points
- Gold standard for diagnosis of many intestinal disorders
- Multiple techniques available based on site and indication
- High diagnostic yield when properly performed
- Essential for celiac disease diagnosis
- Critical for inflammatory bowel disease evaluation
Biopsy Methods
- Endoscopic Biopsy
- Upper endoscopy (EGD)
- Colonoscopy
- Push enteroscopy
- Capsule endoscopy with biopsy capability
- Suction Biopsy
- Crosby capsule
- Watson capsule
- Primarily for small bowel
- Surgical Biopsy
- Open surgical approach
- Laparoscopic technique
- Full-thickness sampling
Common Indications
- Suspected Celiac Disease
- Positive serological tests
- Family history
- Growth failure
- Inflammatory Bowel Disease
- Chronic diarrhea
- Abdominal pain
- Weight loss
- Growth failure
- Other Conditions
- Eosinophilic disorders
- Graft-versus-host disease
- Unexplained malabsorption
- Chronic diarrhea evaluation
- Hirschsprung's disease
Special Considerations
- Age-specific conditions
- Growth and development impact
- Nutritional status
- Previous diagnostic attempts
Absolute Contraindications
- Severe coagulopathy
- Acute peritonitis
- Intestinal perforation
- Severe cardiopulmonary instability
Relative Contraindications
- Recent gastrointestinal bleeding
- Severe thrombocytopenia
- Large vascular malformations
- Acute infectious conditions
- Significant bowel obstruction
Pre-procedure Preparation
- Laboratory Studies
- Complete blood count
- Coagulation profile
- Comprehensive metabolic panel
- Relevant serologies
- Preparation Requirements
- Fasting guidelines
- Bowel preparation if needed
- Medication adjustments
Endoscopic Procedure Steps
- Anesthesia/sedation administration
- Endoscope insertion and advancement
- Mucosal assessment
- Site selection for biopsy
- Multiple biopsies (4-6 samples)
- Specimen handling and orientation
- Documentation of locations
Sample Processing
- Immediate Handling
- Proper orientation
- Fixation methods
- Transport media selection
- Special Studies
- Immunohistochemistry
- Electron microscopy
- Molecular studies
Key Histological Features
- Villous architecture
- Inflammatory infiltrates
- Crypt architecture
- Epithelial changes
- Special staining requirements
Immediate Complications
- Bleeding
- Minor oozing
- Significant hemorrhage
- Perforation
- Pain
- Infection risk
Delayed Complications
- Delayed bleeding
- Post-procedure infection
- Adhesion formation
- Procedure site pain
Immediate Post-Procedure Care
- Recovery Monitoring
- Vital signs
- Pain assessment
- Bleeding monitoring
- Diet advancement
- Discharge Criteria
- Stable vital signs
- Pain control
- Oral tolerance
- Parent education completed
Follow-up Care
- Activity Restrictions
- Diet Guidelines
- Warning Signs Review
- Follow-up Appointments
- Results Discussion Plan
Long-term Management
- Results interpretation
- Treatment planning
- Follow-up schedule
- Monitoring requirements
- Need for repeat biopsies
